Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study
Background In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking. Goal and methods...
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| Veröffentlicht in: | Cephalalgia 2016-12, Vol.36 (14), p.1385-1388 |
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| container_title | Cephalalgia |
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| creator | Koppen, H Stolwijk, J Wilms, EB van Driel, V Ferrari, MD Haan, J |
| description | Background
In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking.
Goal and methods
Using the Delphi approach, we interviewed 22 international clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of cluster headache patients using HDV.
Results
The panel agreed only on performing pretreatment EKG to screen for pre-existing cardiac arrhythmia. Pretreatment EKG was deemed not necessary by most panel members for patients who did not have cardiac adverse events during a previous period of cluster headache attacks treated with HDV. Half the panel advised Holter EKG for patients on verapamil ≥ 480 mg/day. The highest recommended daily doses varied between 240 and 960 mg. Contraindications for use of verapamil largely followed FDA guidelines.
Discussion
Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments. |
| doi_str_mv | 10.1177/0333102416631968 |
| format | Article |
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In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking.
Goal and methods
Using the Delphi approach, we interviewed 22 international clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of cluster headache patients using HDV.
Results
The panel agreed only on performing pretreatment EKG to screen for pre-existing cardiac arrhythmia. Pretreatment EKG was deemed not necessary by most panel members for patients who did not have cardiac adverse events during a previous period of cluster headache attacks treated with HDV. Half the panel advised Holter EKG for patients on verapamil ≥ 480 mg/day. The highest recommended daily doses varied between 240 and 960 mg. Contraindications for use of verapamil largely followed FDA guidelines.
Discussion
Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments.</description><identifier>ISSN: 0333-1024</identifier><identifier>EISSN: 1468-2982</identifier><identifier>DOI: 10.1177/0333102416631968</identifier><identifier>PMID: 26868817</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><subject>Cardiologists ; Cluster Headache - diagnosis ; Cluster Headache - drug therapy ; Delphi Technique ; Electrocardiography - methods ; Humans ; Internationality ; Random Allocation ; Vasodilator Agents - therapeutic use ; Verapamil - therapeutic use</subject><ispartof>Cephalalgia, 2016-12, Vol.36 (14), p.1385-1388</ispartof><rights>International Headache Society 2016</rights><rights>International Headache Society 2016.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c337t-4c5611d86a1b63e480d7a87e8b4a0810ee7f93650db06015fb0f8364d8cb2a463</citedby><cites>FETCH-LOGICAL-c337t-4c5611d86a1b63e480d7a87e8b4a0810ee7f93650db06015fb0f8364d8cb2a463</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0333102416631968$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0333102416631968$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21966,27853,27924,27925,44945,45333</link.rule.ids><linktorsrc>$$Uhttps://journals.sagepub.com/doi/full/10.1177/0333102416631968?utm_source=summon&utm_medium=discovery-provider$$EView_record_in_SAGE_Publications$$FView_record_in_$$GSAGE_Publications</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26868817$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koppen, H</creatorcontrib><creatorcontrib>Stolwijk, J</creatorcontrib><creatorcontrib>Wilms, EB</creatorcontrib><creatorcontrib>van Driel, V</creatorcontrib><creatorcontrib>Ferrari, MD</creatorcontrib><creatorcontrib>Haan, J</creatorcontrib><title>Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study</title><title>Cephalalgia</title><addtitle>Cephalalgia</addtitle><description>Background
In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking.
Goal and methods
Using the Delphi approach, we interviewed 22 international clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of cluster headache patients using HDV.
Results
The panel agreed only on performing pretreatment EKG to screen for pre-existing cardiac arrhythmia. Pretreatment EKG was deemed not necessary by most panel members for patients who did not have cardiac adverse events during a previous period of cluster headache attacks treated with HDV. Half the panel advised Holter EKG for patients on verapamil ≥ 480 mg/day. The highest recommended daily doses varied between 240 and 960 mg. Contraindications for use of verapamil largely followed FDA guidelines.
Discussion
Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments.</description><subject>Cardiologists</subject><subject>Cluster Headache - diagnosis</subject><subject>Cluster Headache - drug therapy</subject><subject>Delphi Technique</subject><subject>Electrocardiography - methods</subject><subject>Humans</subject><subject>Internationality</subject><subject>Random Allocation</subject><subject>Vasodilator Agents - therapeutic use</subject><subject>Verapamil - therapeutic use</subject><issn>0333-1024</issn><issn>1468-2982</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kD1PwzAURS0EoqWwMyGPLAE7Tp5dtqp8SpVYYEOKnPilcZXEwU6Q-u9J1cKAxPSk-869wyHkkrMbzqW8ZUIIzuKEAwg-B3VEpjwBFcVzFR-T6e4d7f4TchbChjGWAoNTMolBgVJcTsnHUntjdUEb19reeduuqStpZddVZFxA-oVed7qxNbUtLeoh9OhphdroosI7umjHfIxa3VvX6preY91VloZ-MNtzclLqOuDF4c7I--PD2_I5Wr0-vSwXq6gQQvZRUqTAuVGgeQ4CE8WM1EqiyhPNFGeIspwLSJnJGTCeljkrlYDEqCKPdQJiRq73u513nwOGPmtsKLCudYtuCBlXMUAqUylGlO3RwrsQPJZZ522j_TbjLNs5zf46HStXh_Uhb9D8Fn4kjkC0B4JeY7Zxw2ijDv8PfgNwDX3s</recordid><startdate>201612</startdate><enddate>201612</enddate><creator>Koppen, H</creator><creator>Stolwijk, J</creator><creator>Wilms, EB</creator><creator>van Driel, V</creator><creator>Ferrari, MD</creator><creator>Haan, J</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201612</creationdate><title>Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study</title><author>Koppen, H ; Stolwijk, J ; Wilms, EB ; van Driel, V ; Ferrari, MD ; Haan, J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c337t-4c5611d86a1b63e480d7a87e8b4a0810ee7f93650db06015fb0f8364d8cb2a463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Cardiologists</topic><topic>Cluster Headache - diagnosis</topic><topic>Cluster Headache - drug therapy</topic><topic>Delphi Technique</topic><topic>Electrocardiography - methods</topic><topic>Humans</topic><topic>Internationality</topic><topic>Random Allocation</topic><topic>Vasodilator Agents - therapeutic use</topic><topic>Verapamil - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koppen, H</creatorcontrib><creatorcontrib>Stolwijk, J</creatorcontrib><creatorcontrib>Wilms, EB</creatorcontrib><creatorcontrib>van Driel, V</creatorcontrib><creatorcontrib>Ferrari, MD</creatorcontrib><creatorcontrib>Haan, J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cephalalgia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Koppen, H</au><au>Stolwijk, J</au><au>Wilms, EB</au><au>van Driel, V</au><au>Ferrari, MD</au><au>Haan, J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study</atitle><jtitle>Cephalalgia</jtitle><addtitle>Cephalalgia</addtitle><date>2016-12</date><risdate>2016</risdate><volume>36</volume><issue>14</issue><spage>1385</spage><epage>1388</epage><pages>1385-1388</pages><issn>0333-1024</issn><eissn>1468-2982</eissn><abstract>Background
In many patients, high-dose verapamil (HDV) is the only effective prophylactic treatment for cluster headache. Although cardiac adverse events and EKG abnormalities are relatively common, evidence-based guidelines for screening and monitoring patients on HDV are lacking.
Goal and methods
Using the Delphi approach, we interviewed 22 international clinical experts in cardiac rhythm disorders to formulate EKG guidelines for the pretreatment screening and monitoring of cluster headache patients using HDV.
Results
The panel agreed only on performing pretreatment EKG to screen for pre-existing cardiac arrhythmia. Pretreatment EKG was deemed not necessary by most panel members for patients who did not have cardiac adverse events during a previous period of cluster headache attacks treated with HDV. Half the panel advised Holter EKG for patients on verapamil ≥ 480 mg/day. The highest recommended daily doses varied between 240 and 960 mg. Contraindications for use of verapamil largely followed FDA guidelines.
Discussion
Experts in cardiac rhythm disorders agreed on pretreatment EKG monitoring, but no consensus was reached on EKG monitoring during HDV treatment and around dose adjustments.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>26868817</pmid><doi>10.1177/0333102416631968</doi><tpages>4</tpages></addata></record> |
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| ispartof | Cephalalgia, 2016-12, Vol.36 (14), p.1385-1388 |
| issn | 0333-1024 1468-2982 |
| language | eng |
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| source | SAGE Journals |
| subjects | Cardiologists Cluster Headache - diagnosis Cluster Headache - drug therapy Delphi Technique Electrocardiography - methods Humans Internationality Random Allocation Vasodilator Agents - therapeutic use Verapamil - therapeutic use |
| title | Cardiac monitoring of high-dose verapamil in cluster headache: An international Delphi study |
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